Healthcare Provider Details

I. General information

NPI: 1912056243
Provider Name (Legal Business Name): PENINSULA ALLERGY & ASTHMA ASSOCIATES P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PINE BLUFF ROAD SUITE 28
SALISBURY MD
21801
US

IV. Provider business mailing address

201 PINE BLUFF ROAD SUITE 28
SALISBURY MD
21801
US

V. Phone/Fax

Practice location:
  • Phone: 410-742-5599
  • Fax: 410-742-4873
Mailing address:
  • Phone: 410-742-5599
  • Fax: 410-742-4873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberC10005689
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD0050650
License Number StateMD

VIII. Authorized Official

Name: CURT M WATKINS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-742-5599